胸腰椎骨折伴脊髓损伤手术方式选择

目的：探讨胸腰椎骨折伴脊髓损伤前后路手术各自的优缺点、适应证以及内固定物的选择。方法：回顾1992年1月－2000年4月手术治疗胸腰椎骨折伴脊髓损伤53例，其中后路手术43例，前路手术10例；总结手术方法及手术疗效。结果：获6个月以上随访41例，脊髓神经功能术前为A级3例，术后均无恢复；其他在术后均有1－3级恢复；前后路手术对神经功能恢复无法做比较；椎体复位后路手术43例有11例欠佳，前路手术10例均达解剖复位。结论：前后路手术各有其较明确的适应证，应按照受伤节段、CT显示椎骨受压情况及神经损伤程度进行选择；后路手术存在远期或取钉之后椎体高度再丢失问题，前路因其能达到生物学固定而远期稳定效果良好。

The Selection of operative Procedures for Thoraco-lumbar Fracture Complicated with Spinal Cord Injury

Objective: To explore the effects and indications of anterior or posterior approach operation to treat thoraco-lumbar fracture complicated with spinal cord injury;to discuss the selection of the material of internal fixation.Methods: 53 cases of thoraco-lumbar fracture accompanied with spinal cord injury were operated from Jan.1992 to Apr.2000.43 cases were treated by posterior approach operation and 10 cases by anterior approach.Results:41 cases were followed-up over 6 months.3 cases that ASIA(American Spinal Injary Association)impairment scale of preoperation showed A had no recovery.Others were recovered from 1-3 scale after operation.The level of recovery of spinal cord injury could not be compared between anterior approach and posterior approach.In 43 cases of posterior approach operation,11 cases could not recover the height of vertebral body after operation.In all 10 cases of anterior approach operation,the fracture of vertebral body achieved anatomical reduction.Conclusions:The indications anterior approach and posterior approach operation could be defined according to the segment of injured vertebra,the compressed position of spinal cord that was showed by CT and the impairment scale of spinal cord.That the height of vertebral body lost again could be found in long-term follow-up in the posterior approach operation.The late result of the anterior approach operation was good because it could achieve the biologic fusion in the injured vertebral body.